Updated: Jun 30, 2020
When completing some online ward simulations I found myself extremely confused regarding how many mls of fluids to provide in flushes and how many times a day. I have had a fair bit of feedback regarding this from some amazing dietitians and also students on Instagram and furthermore, I have had a few students ask me to share what help I have been provided with.
It depends on the patients feeding and medication regime. If fed for 20 hours they would usually have breaks in the feed for medication. eg. 3 med sessions a day plus feed = flush before and after each time you start the feed and before and after each medication. Flushes can be anything but the syringes are generally 60ml which makes things easier! Everyone does it different and it is usually based around patient preference/needs.
It is dependant on fluid requirements and also if on IV fluids. A pre and post flush is always required when being NG fed to make sure the tube is free to have feed flowing. Generally pre and post flush can be 50 or 100mls. If the persons fluid requirements are quite high then opt for the 100mls as that would be 200mls (pre+post) counting to their fluid intake. There is not a definite number of how many flushes a person has. A person may have a fluid req of 2L, the feed mau provide 1000mls and then they will have 100ml pre and post feed flush, totally 1200mls. They are then still in a deficit of 800mls so you need to find out if on IV as this will likely cover the deficit. If they aren't, you could write on your regime, deficit of 800mls, please ensure this provided via extra flushes with meds at a max flush of 200mls- to ensure don't do a large flush the patient may not tolerate. Make sure to find out if the patient is also drinking themselves as this will reduce flushes.
Depends, if feed is running for 20 hours you would pause the feed, flush and provide meds then flush again and reconnect the feed then repeat as needed! Sometimes you can add flushes to make up fluid intake to decrease/elimintate the need for IV fluids. You can provide all kinds of volumes of flushes, id say a minimum of 30ml depending on viscosity of feed (I usually go 50ml) and can bolus up to tolerance (I wouldn't normally bolus more than 250ml at a time). Always consult the nurse regarding meds. You need to be extra careful if a patient is on a fluid restriction as you need to be more precise- ward staff should be extra detailed in their documentation as you'd count soups/custard/yoghurt as fluid in addition to drinks.
We rely on documentation from nursing staff/whoever is filling out food and fluid balance charts and all our recommendations are based on estimates. If in doubt, consult the latest PENG handbook and NICE guidelines for fluid requirements for different ages, gender, clinical conditions.
The tube is flushed any time there is a break in the feed. So if fed for 20hrs continuously there would only be a flush pre and post feed BDS and then again pre and post meds - depends on how many meds given and whether given at different times of the day. In terms of volume, I think we were taught 60-100ml but I don't think there is necessarily a set number. If the patient is on a fluid restriction, you may choose 60ml or if they have higher fluid requirements you may choose 100+.
Estelle Kearney (@estelledietitian)
It differs for every patient depending on a number of factors and is down to clinical judgement. The number of flushes may depend on how often the pt requires their meds to be administered. Standard volume is usually 60-100ml but for example, if a patient is on a fluid restriction it might be lower or higher for those with higher fluid requirements. If a patient is provided with flushes X5, then perhaps they are being bolus fed or have meds that need to be administered at certain times.
Another dietitian (Anon)
It's recommended to do 60-100ml pre and post fed and meds to stop it blocking. 20-30ml can also be provided between each medication. A patient may then need more flushes throughout the day to meet requirements.